FAI Hip Impingement (Femoro-acetabular Impingement)

FAI Hip Impingement Awareness facts - It is estimated that approximately 15% of the young, adult population have hip impingement, so who do you know that might have it?
Hip impingement causes painful labral tears within the hip socket.
Hip FAI symptoms are misleading to the average medical professional, as FAI hip impingement pain frequently presents as low back pain and interesting only 10% of back pain is ever clinically diagnosed and cured... Which begs the question what percentage is actually caused by hip FAI or hip impingement, as its otherwise known.
The more active you are, the more likely you are to trigger hip impingement symptoms, so busy mums and gym bunnies beware... but at least you're in good company as many premiere league football players have also suffered FAI hip pain.
Hip impingement is diagnosed through x-ray and labral tears are diagnosed through MRI arthograms - but both need to be read by hip consultants specifically trained in FAI hip impingement.
There are 60,000 hip replacements every year in the UK and it now appears that FAI hip impingement, over the years, could be the leading cause of hip osteoarthritis. A silent epidemic.
Hip arthroscopy can reduce the hip impingement and reattach the torn labrum to the hip socket. This surgery can eliminate the pain and disability caused by FAI hip impingement and divert the need for hip replacement in later life.


Also please feel welcome to join in our help and advice forum for support. We have 3 advising FAI expert hip surgeons, 3 PT/physios and a sports medicine doctor as well as the largest international FAI hip impingement forum on the net:

Wednesday, 18 November 2009

pavlik harness and CHD Congenital hip dysplasia - baby



Baby hip dysplasia and the pavlik harness is something I've been meaning to cover. Should you have a hip problem, like myself, it is worth getting your babies double checked. They say first born girls and breech are most likely to develop this, my daughter was neither, she was second born and cephalic presenting. My personal experience with my daughter Isabella is below and also I have set up a facebook support group forum at: https://www.facebook.com/groups/HipDysplasiaInBabies/ which is a great place to meet other parents in the same boat.
My daughter, now one, slipped through the hospital first day check, health visitor's first week check and doctor's 6 week check. They spread the legs backward to see if the hips click and dislocate. The trouble is, that does not cover all the bases..My daughter, Izzy, her hips never actually dislocated out of the socket.

By 4 and a half months my hubby and myself grew increasingly concerned at Izzy's leg length discrepancy, we had passed it off as that new born twisted, scrunched up look, they often have as newborns and so had the professionals. I was reassured several times over. Until one day the LLD Leg length discrepancy struck me as dramatically obvious. I googled it (thank God for google!!) and she ticked a lot of the boxes and thought I'm almost sure this is her problem. Then took her back again to my GP.
He insisted 1cm LLD was normal ..I pointed out 1 cm on an adult maybe, but on a baby 56cms long, I wasn't so sure he was right that that was normal. At this time I had no idea I had a hip problem too, just ongoing pain from 'something' and said I wasn't prepared for them to also miss something on my daughter and wouldn't leave without a scan for her!

I got the scan for Izzy 2 weeks later and she did have hip dysplasia. Her acatabulum was 10 degrees away from normal and was too shallow. For some reason and they said congenital, her left hip hadn't fully developed. They asked who had a hip problem within my immediate family, I said no-one that I knew of, the irony! (within a month I found out my mystery pain of 6 years was my hip too)

She was immediately put into a pavlik harness.

The pavlik harness was something I'd worried about a great deal when reading up on dysplasia, but its actually very straight forward to use. It's light, its easy to wash and its best for you if you make permanant ink marks where the straps are set so you can KNOW where to fasten it if you take it off and want to put it back on and you'll become aware when they're growing too as the markers need to move. It can cause babies to have a little more wind that usual, but certainly in our case nothing significant.
The biggest nightmare was her wardrobe. She couldn't wear trousers, babygrows (unless super large) or any dress that wasn't designed to flare out as they would simply ride up to tee shirt height! So she wore party dresses the whole time because they all kicked out at the chest like little princess dresses!!
The other difficulty was seating her. Our pram, the bugaboo was fine and I believe the quinny zap is wide and good with a harness also, probably the vest in my experience because of its wide seat shape. The stoke highchair also fine. Maxi cosi rear facing car seat was ok, with a little cushion under her bottom to boost her and allow her hips to spread out. I also understand there is a special britax seat designed for this should your child be older, or in a pot version. There are products, but it can get expensive and it seems unnecessary for hopefully such a temporary length of time.

So at a LATE four and a half months (best results, if applied before 6 weeks) she began wearing her pavlik harness. Initially 24 hours everyday for 6 weeks. At the end of six weeks she only moved 1 degree and they said surgery would be the next step should she not progress and to brace ourselves as she was now six months and very few babies made progress after 6 months. However we went along with it, for another 6 weeks of wearing the pavlik harness night and day. She was allowed an hour of per day, but we couldn't see the point, other than for bathing, as it upset her more to put it back on. Once on, she barely noticed the pavlik harness, although in the final weeks seemed to kick against it. In the last month she suddenly had a growth spurt and this I am 100% sure is what caused the harness to suddenly work as at our next assessment she progressed the full 10 degrees! We were stunned! Thank you thank you thank you is all we could think.

She worn the pavlik harness until seven and a half months old. It delayed her sitting at six months, but within literally 2 weeks of the pavlik harness coming off, she could sit unaided AND CRAWL!! The harness actually really strengthened her legs! Now she is walking and ahead of a lot of her peers, which is a real shock! Do not fear it will hold your child back. Having said that as you can see just after the harness was removed she did sit in THE MOST unladylike fashion!!
We do still however have a couple of concerns, in that she favours her good leg and there is still a twist to her, but we are assured all is well and that as she becomes more mobile, using all those muscles, that these problems will disappear.

All in all its not the most pleasant thing to put your baby through, but honestly it'll probably irritate you more than them, Your biggest problems will be highchairs and clothes (but girls, its a great excuse to buy all those frufru dresses and they go for a song, virtually unworn other than for the odd occasion, on ebay!)

She has just had her one year assessment and all is looking well ...so most importantly we might just have saved her from a lifetime of pain and operations.
Ironically it prompted those around me to consider my hip as the source of my 6 year unexplained pain, so 'she' probably also saved me from a lifetime of pain too!

Anyone readying this retrospectively contact me directly if you need any help/advice re how to cope with the pavlik harness etc, I'm at louisa.w@virgin.net

ps ask for 2 pavlik harness from the hospital, they won't automatically give you two and should you have a spill or nappy disaster it makes life easier!

I have just set up a facebook support group, in the groups section of facebook called 'hip dysplasia in babies' (clicky hips or CHD, DDH) I have put on LOTS of links to advice pages, to make it easier for others to search for advice, equipment, help. https://www.facebook.com/groups/HipDysplasiaInBabies/
Also as more people find this facebk support group, we can help each other.

Best of luck!

28 comments:

  1. Louisa,
    I didn't realize this. Sorry you and Izzy had to go through that. Hope she will be improving and her Mommy too!! Thanks for sharing, I'm sure it will be a great to help to other parents facing this as well.

    Vanessa

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  2. oh, and by the way, how CUTE is she!!!

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  3. Oh yes its been a proper year of hip horrors!! But Izzy got the all clear last week on 1 yr x-ray, so all's well that ends well and all that! Just it felt scary at the time and thought might be reassuring for anyone ready getting there baby fixed quite late by normal standards.
    Cute, yes a real character, already, loves pulling mad faces as you can see in the last pic!

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  4. Your baby girl is ADORABLE! My 10 week old daughter was just diagnosed as well. We see the orthopedic doctor tomorrow. She will most likely end up with the brace!! Thanks for tips!!

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  5. I'm sure she will be fine and its not as horrific as it all sounds, babies adapt better than us! Best of luck.

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  6. Harness sounds better than the full plaster i had as a child! I wasn't seen until i actually couldn't walk so i was around 18 months old. I have to keep checking my girls each year even though they are now 17,15,12,9 yrs old just in case they develop it at a later date.

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  7. Didn't know it could develop later! Ekk... yes I was told had I not picked it up on Izzy, then it would've most likely been spotted by her dragging a leg crawling, or limping. I thank my lucky stars it didn't get that far, poor you and 4 daughters, my other child is a little boy, 4, no hip problems.

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  8. My daughter also had a hyp dysplasia. we found out when she was 2 months old.I freakd out I did not eat for one week. she had to wear the harnes which it was a night mare for 2 days she did not sleep, then she got use to it.she had to wear the harnes 1 week then 1 week off then 2 weeks on and then 2 weeks onn only for 8 hours during night time. she went for ultrasong and thenk got everything come out 100%. is not as bad as it looks. I really recomend her doctor and the hospital to any one who needsit. for any info u can E-mal me at Naile17@aol.com

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  9. HEY IZZY'S MOM!! HOW ARE YOU AND YOUR FAMILY DOING?? I WANT TO THANK YOU FOR ALL YOUR INFORMATION!!IT WAS INDEED HELPFUL..AS MY 3 MONTH OLD DAUGHTER HAVE BEEN DIAGNOSED AND GIVEN A PEVLIK HARNESS!! I HAVE ONE QUESTION FOR YOU! AFTER THE HARNESS WAS REMOVED DID IT DO ANY DAMAGE TO HER SHOULDER OR HER SKIN?? OR ANY DAMAGE AT ALL!! AND DID HER LEG LOOK FUNNY IN ANY WAY AFTER REMOVING IT!! LIKE HER LEG SPREADED APART OR ANYTHING!! THANK YOU AGAIN FOR THE INFO!! GOD BLESS YOU AND YOUR FAMILY

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  10. thank you for sharing your story my son has been in his harness since he was 8 weeks old he is now 21 weeks old reading your story has boosted my confidence as i was a little worried about his milestone i actually got a tear reading about your daughter we go to this week to find out if we can take ours off after being already and been told it wasn't at 50% yet we are crossing everything it has been a long 13 weeks as we were not aloud to remove the harness and had regular visit with the phsyio BUT it will all be worth it in the end and you are right it does not worry them much :-)

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  11. HI first anonymous, no problems at all with the harness for Izzy during or after, although for a month or so she would sleep and often sit with her legs wide apart, it caused LOTS of giggles as people thought she was an uber chilled out baby!! Now 8 months on nothing, you'd never know and she's running about chaising her brother and sometimes I catch yself watching her run and am so thankful!
    Anonymous two what did they say, is your son harness free yet? I am sure so much is down to growth spurts.. Izzy had non in her 1st 6 wk of harness and then grew in the 2nd 6 week of harness and that's when her hips really improved and became normal. So I think much will be down to when your son grows., you've a great chance of success in those early weeks.
    For anyone who doesn't get a reply, apologies as I tend to reply to latest blog comments and don't see these unless I travel back some month, so please feel free to email me at louisa.w@virgin.net

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  12. Oh I would say we put harness on over a cap sleeve vest though and that might've help with rubbing, also washed in in lenor softener and put marker pen marks where to fasten to make it easy to put back on.. Forgive me if I mentioned those tips already.

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  13. hi ive enjoyed reading your little girls story,made me feel much better to know im not the only one getting irritated with the harrness!! my doctor cant be as good as all your because he hasnt explained any persentages or degrees or any thing along those line.just said its slighly shallow and wear this harness for 4 weeks,come back and we seee how things go!!! im now a week and a half left to go be for we go back and praying its improved!! i know this might sound stupid!! but i book a photogrpher be for we had to wear the harness and he ment to come tomorow,do you think it would do and harm taking the harness off for an hour while she has them done?

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  14. Hi My sister Just had her baby and she just found out that she Has DHD, They said that she will need a brace or worst case surgery. I love your blog i'll make sure to pass it on, and i hope that little Izzy is doing well. My sisters baby's name is Izabella. What should she expect for time with the brace?Well take care.

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  15. My daughter too had been diagnosed with her left hip at birth. At 2 weeks old, the orthopedic doc put her in a pavlik harness and was told atleast 3 months she'd have to wear it and we had to get ultrasounds done every 3 weeks to check and see how its developing and healing. Well when she was 6 weeks old, her ultrasound revealed that it was 100%!!!! I was soooooo HAPPY and could only thank God for his help!! The doctor too was very happy and told us to continue wearing it for another 4 weeks just to make sure it closes up nice and tight in the socket and that she'd be able to get it off on April 7th. For all you moms out there, hang in there...it was tough at first, but soooo worth it in the end =). God Bless all babies and may he heal each and everyone of them!!

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  16. HI.. nice io hear good news.. and re question to remove it for an hour I can only say in our case we were told an hour per day off was ok, we just didn't do it because after removing it it was more stressful for her to have it back on and we only took it off briefly at bath time. However your situation my be different so I wouldn't like to say yes, though I suspect yes.
    For anyone needing faster advice contact me thru my email as I may not see this old part of the blog for weeks. Louisa.w@virgin.net

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  18. Is there any exercises the baby can be given to help with this before having the braces. Our 2 month old baby just has had her first scan as she was a big baby and they said it was ususal practice to have a scan on a big baby. We have been told that her left socket is shallow, and to come back for a further scan. I am hoping and praying she is better for the next scan.

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  19. Not that I know of... but get the harness on your baby asap, the longer you wait the less success, Izzy had hers on at 4 and half mums because of the delayed diagnosis and we found out only 3 months ago that it has failed, having last yr been told it worked!
    I have just set up a facebook support group if your on facebook, called "hip dysplasia in babies (clicky hips or CHD, DDH)" type that into facebook and it should appear and I have put on LOADS of links to advice pages, to make it easier for others to search.
    Also as more people find this facebk support group we can help each other.


    Best of luck keep in touch!

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  20. Found your blog very interesting. I had my first child in 1982 a beautiful daughter born with CDH which we only discovered when she wss a year old. After numerous drs visits, (no internet in those days!) we relented and she was put into a plaster cast for 9 months from her hips to her toes with a cross bar - long story short - she became a national synchronised swimmer at age 12! we are now looking into her recent hip pains and found you - interesting that we can swop stories.
    We will see dr next week, hopefully nothing to worry about. Good luck to you all.

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  21. good luck to you and your daughter, technology and knowledge is increasing all the time, research the best and use patient choice if you're not private. All the best.

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  22. Hi, thanks for the info.. my son has gt a harness on hes had it on since he was 2weeks old he is now 4months old and has still got it on! Can he be laid on his belly? He is staring too want down all the time now. He has had two ultrasounds, and there has been a small improvement. We go back too see our consultant on the 26th jan, so i am praying that he can finally get it off. The consultant said that he wants both hips to basically touch the floor when his legs are wide open. But i cant see him getting it off.... Thanks again for the info hope your family is doing well...

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  23. HI anonymous, I understand the urge to no longer have the annoying harness but honestly if it fixes him you will thank yourself a 1000 times over. It can work and he has a good chance statistically starting so young and all the alternatives are much much worse for you and him. I wish you both good luck and patiece. I'm no expert but I see no reason why he can't lay face down in his harness, just don't leave him alone (not that you would) doing that as he is still teeny, Is your health worker any help, mine was lovely and helpful. For peace of mind perhaps call the dr's secretary and ask her to ask your specialist if its ok for him to lay on his front. Have you found the facebook page yet... more opinions and support there. I only dropped by here on the off chance.

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  24. Thank you very much, im looking forward to go on the 26th jan, so ill let you know if he gets it off... I think he will but on the other hand im not going to get myself worked up as i have done that before and he had too keep it on so... Ijust going to expect him to be getting it back on... Thanks again..

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  25. hi, my daughther is 1 month old and they will be putting her brace tomorrow, she will be wearing it for a month... but i was wondering if when she grows up she's going to be walking with her legs spread out like if she had the brace ??

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  26. No not at all, in the weeks after my daughter was out of here she sat v spread legged and people would laugh and say how relaxed she look, but then not a trace of it, don't worry come join the baby hip dysplasia group on facebook for some support.

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  27. Hi I'm Cathy! Thank you very much for all this information and for the concern to share them. My son (almost 7 weeks old) just had his harness on yesterday and since then, I've been in a little freak out mode as I am so concerned about how this can hinder his growth and that it can cause rashes and irritations on the skin. (By the way, does it? and what have you used to treat them?)
    After reading this, I felt more empowered and hopeful that he'll have the same results as your cutie baby.

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  28. Hi Cathy, you just came onto' hip dysplasia in babies (clicky hips or CHD, DDH)' hi... yes get 2 harness's, trust me you'll need them and always wash them in softner, makes a real difference. also try to put on clothes that block any rub areas. We had Izzy's vest on and somethings leg warmers and long socks. She never had a rash or sore spot.
    I imagine its harder to dress a boy I had the fru fru dress option but I'm sure someone will know, perhaps cool t shirts and leg warmers. It totally doesn't hinder growth and its brilliant if they have a growth spurt whilst in the harness and it brings on development within the hip.
    I can, hand on heart, say I found it harder than my daughter. Let me know how you get on.
    ps The only thing to watch out for in my experience in wind because of the lack of kick ability... it was never bad but good to get some infacol in.

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